Dealing with Post-Acute Withdrawal Syndrome
Articles about addiction recovery almost always imply that recovery begins with detox. Once all the active drugs are out of a person’s system, the theory goes, everything about life and health will get better.
That might be true for the majority of people living with addictions. As soon as these people complete medical detox, they feel a whole lot better about almost everything. But there are some people who have a path to recovery that takes a few twists and turns.
For example, in a study of people in recovery from benzodiazepine addiction, published in Psychiatric Annals, researchers found that about 10-25 percent of these people had withdrawal symptoms that lasted for many months. While some people felt better almost immediately, some simply did not.
This is known as a post-acute withdrawal syndrome (PAWS). While it can complicate recovery, there are a number of things people can do in order to both understand and deal with the condition.
Signs and Symptoms
An acute withdrawal syndrome is characterized by severe symptoms of distress. Someone in acute withdrawal from opiates, for example, might feel flu-like symptoms, such as nausea and muscle cramping. Someone in acute withdrawal from alcohol, on the other hand, might experience tremors and/or seizures. These are the symptoms that take hold quickly and be effectively managed in a formal detox program.
After a few days, these signs fade away and medical detox programs come to a close, but at this point, new symptoms can appear due to PAWS. Those symptoms can vary, depending on the drug the person took on a regular basis, but the University of Wisconsin suggests that common symptoms attributed to PAWS include:
These symptoms are typically associated with the use of benzodiazepines like Xanax or Valium, but they can be triggered by other drugs, too. Psychology Today reports that PAWS is quite common among people taking prescription painkillers. Other sources have found PAWS in people who have taken other drugs.
People with addictions may be prepared for the fact that they will not feel their best in the days following the cessation of drug use. They may be ready for at least a little bit of distress and discomfort, but PAWS can be devastating simply because it lasts for such a long time.
In a study in the journal Substance Use and Misuse, researchers examined the impact of PAWS in people recovering from alcohol addiction. Many of the people in this study dealt with anhedonia, which is an inability to feel pleasure. These people felt cold when they were in the presence of things that once made them happy. No matter how much they tried to recapture the joy they once felt in their lives, that happy emotion continued to evade and elude their grasp. In this study, that symptom of joylessness lasted for more than a year. That is an incredibly long time during which to feel joyless and unhappy.
In a similar study in Addictive Behaviors, researchers examined people in recovery from opiate/opioid addiction. These 116 people had access to a replacement medication for craving control, yet it took them more than 40 days before they felt their symptoms of withdrawal begin to abate. During that time, they did not feel severe symptoms of withdrawal, but they also did not feel as though they had returned to the happy state they felt before they started to use drugs. They still felt altered, and that feeling persisted for a month or longer.
Some PAWS symptoms can last even longer. In a study cited by the Substance Abuse and Mental Health Services Administration,
researchers found that sleep disturbances caused by alcohol PAWS could last for up to three years.
These people had trouble falling asleep, they slept less, and they showed signs of sleep apnea throughout the night. Clearly, they were not experiencing a restful sleep, and PAWS was to blame.
PAWS develops due to brain damage caused by drugs. While people who have been through medical detox have bodies that are technically free of drugs, their brain cells remain tainted with the kiss of drugs, and it is that damage that impacts the way people feel.
Many drugs of abuse tinker with the brain systems that are vital for producing sensations of pleasure and relaxation. Due to the constant presence and stimulation of drugs, these cells have become immune to natural stimulation. In some cases, they have burned out altogether. As a result, people in recovery can feel blank and turned off and numb, simply because their cells are no longer working.
It can be distressing, but the brain is a remarkable organ with the ability to heal itself. Just as the brain was slowly damaged due to the influence of drugs, it can be slowly healed through a natural lifestyle.
With good nutrition, meditation, and rest, brain cells can undo the damage that drugs can cause. Slowly but surely, they can begin to function in the ways they are intended to function. People who have been through this process sometimes refer to it as a slow awakening, and it can take time to accomplish. One woman interviewed for an article by ABC News says she felt “almost normal” after a year of sobriety. It was a long road, but she got there.
Some clinicians encourage their clients to cultivate something known as distress tolerance. In essence, this is the idea that the body can be uncomfortable from time to time, due to illness, withdrawal, or something else altogether, and that sense of discomfort does not need to be managed or otherwise obliterated. The discomfort is a part of life that will pass.
That can be a hard lesson for people to learn, particularly when these people have spent years using drugs and alcohol as medication for pain. When they feel uncomfortable, they have a quick remedy that can whisk that discomfort away with no questions asked. But learning to pass through the moments without correcting them could give the brain cells the time they need in order to heal.
One man in recovery interviewed by The Huffington Post used his therapy to help him put a label on feelings caused by his PAWS. When he struggled with a feeling or task that should be simple, he called it “PAWS-y,” and he forgave himself for the issue and tried to move on.
This could be a good tactic for people to employ in their own lives. But it is also important to remember that PAWS comes with some very real risks, and sometimes, a simple explanation is not enough.
PAWS and Relapse
It is no secret that gaining sobriety is a difficult process that involves a great deal of courage, expense, and strength. It can seem cruel to move all the way through the detox and rehab process and still feel just as terrible as one did when detox began. For some people, PAWS can undermine recovery and make relapse seem easier.
This is an easy trap to fall into, and it is vital for people experiencing PAWS to stay firm in their recovery plan. For some people, that means staying engaged in the rehab process in an active manner.
Some people use sober living homes to deal with PAWS. They do not trust that they will be able to stay sober while living in the communities where they once used drugs, so they seek out homes where they will live with others in recovery. That peer support could be vital in dark moments, and the rules of the home could ensure that temptations are banished.
Others make a commitment to the 12-Step movement. They may go to meetings once or twice a week, and then reach out to the community for added support between meetings. Members of these groups are often happy to meet for coffee, chat on the phone, head out for recreational opportunities, and otherwise lend a hand to someone in need. That sense of giving is deeply embedded in the 12-Step ethos, and it could be vital for people with a recovery blighted by PAWS.
People who do have a PAWS relapse are not doomed to a full return to addiction. A relapse is simply a sign that the person needs a little more help with recovery. Specific PAWS therapy or some similar intervention could be just what people need when they have a slide due to PAWS. With that help, they could get right back on track as planned.di
While PAWS is very real and it can make recovery complicated, it is not an insurmountable problem. People with this condition can get better, and those who do can be an inspiration for a whole new generation of people with addictions. The key is to start the fight, and to keep on fighting, one day at a time.